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MR appearances of the temporal evolution and resolution of infectious spondylitis
A R Gillams1, B Chaddha, A P Carter
1Department of Radiology, Boston University Medical School, MA USA.
Objective:
We undertook this study to document the MR appearances of evolving or resolving infectious spondylitis.
Materials And Methods:
A retrospective review was carried out of all patients with infectious spondylitis who had undergone MR imaging from 1991-1993 at Boston University Hospital and Boston City Hospital Imaging Foundation. The study population consisted of 25 patients (seven females and 18 males). There was a bimodal age distribution with peaks at 34 and 59 years old (age range, 25-81 years old). The causative organism was isolated in 20. Sixteen had Staphylococcus aureus, two had mycobacterium tuberculosis, and two had gram-negative bacilli. Follow-up MR imaging was performed in 20. Nine had two studies, three had three, five had four, two had five, and one had six. The median length of follow-up was 8 weeks (range, 2-104 weeks). Follow-up MR appearances were correlated with clinical outcome.
Results:
Early imaging revealed atypical appearances. Fourteen of 20 (70%) improved; the first sign of response to treatment was a reduction in the inflammatory soft tissue (8/14, 57%). Changes in the bones or discs concurrently progressed in six of eight patients (75%) including involvement of a new disc level in four (50%). A definitive sign of healing was a peripheral rim of high T1 signal in bone (5/14, 36%). Gadolinium enhancement persisted long after resolution of changes in the soft tissues, for up to a median of 17.5 weeks (range, 8-80 weeks). A subgroup of six IV drug users showed unique radiologic features.
Conclusion:
The early appearances of infectious spondylitis may be atypical. Resolution of soft-tissue change and fat deposition in the bone marrow are reliable signs of healing. Bone or disc changes can progress despite clinical improvement. Gadolinium enhancement can increase and persist after symptom resolution.
Insights
Magnetic resonance imaging (MRI) can show atypical signs of infectious spondylitis. Key healing indicators include reduced soft tissue inflammation and bone marrow fat deposition, though bone changes may persist.
Area of Science:
- Radiology
- Infectious Diseases
- Orthopedics
Background:
- Infectious spondylitis is a serious spinal infection.
- Early diagnosis and monitoring are crucial for effective treatment.
- Magnetic resonance imaging (MRI) is a key modality for evaluating spinal infections.
Purpose of the Study:
- To document the evolving and resolving magnetic resonance (MR) appearances of infectious spondylitis.
- To correlate MR imaging findings with clinical outcomes.
- To identify reliable signs of healing and disease progression.
Main Methods:
- Retrospective review of 25 patients with infectious spondylitis who underwent MR imaging between 1991-1993.
- Analysis of follow-up MR imaging in 20 patients over a median of 8 weeks.
- Correlation of MR findings with clinical outcomes.
Main Results:
- Early MR imaging revealed atypical appearances in infectious spondylitis.
- Reduction in soft tissue inflammation was an early sign of treatment response (57%).
- Bone and disc changes could progress despite clinical improvement; gadolinium enhancement persisted long after soft tissue resolution.
Conclusions:
- Early MR appearances of infectious spondylitis can be atypical.
- Resolution of soft-tissue changes and fat deposition in bone marrow are reliable healing signs.
- Bone/disc changes and gadolinium enhancement may persist even after clinical improvement.